title: Attitudes toward healthy eating: a mediator of the educational level-diet relationship.
abstract: OBJECTIVE
  A higher educational level is associated with a healthier diet. The goal of this study was to establish whether this association is mediated by attitudes toward healthy eating.
  
  
  METHODS
  The cross-sectional MONA LISA-NUT study was performed in 2005-2007 on adults aged 35-64 years from northern and north-eastern France. Diet quality was assessed on the basis of a 3-day food record and a validated score based on French national dietary guidelines. Specific questions investigated attitudes toward healthy eating. Multivariate analyses were used to quantify the proportion of the educational level-diet relationship that was mediated by attitudes toward healthy eating.
  
  
  RESULTS
  Among the 1631 subjects, favourable attitudes toward healthy eating were associated with both higher educational level and diet quality. In the mediation analysis, 'organic food consumption' explained 14% (95% confidence interval (8;24)) of the educational level-diet relationship and 'attention paid to health when buying food' explained 9% (3;16). In contrast, 'attention to food choice', 'searching for information about food' and 'perceived role of eating' were not mediators of the association between educational level and diet. In a multivariate model, the attitude items together accounted for 25% (10;45) of the relationship. The mediation was more pronounced in women than in men (37% (15;54) vs 16% (1;27), respectively) and was significant for consumption of fruits and vegetables (23% (13;37)), whole-grain food (32% (15;58)) and seafood (22% (9;55)).
  
  
  CONCLUSIONS
  Our results suggest that poor attitudes toward healthy eating in groups with low socioeconomic status constitute an additional factor (along with cost constraints) in the choice of unhealthy foods.
authors.affiliation: Service d'Épidémiologie et Santé Publique, INSERM 744, Institut Pasteur de Lille, Université Nord de France, Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Lê
authors.forename: J
authors.initials: J
authors.lastname: Dallongeville
authors.forename: A
authors.initials: A
authors.lastname: Wagner
authors.forename: D
authors.initials: D
authors.lastname: Arveiler
authors.forename: B
authors.initials: B
authors.lastname: Haas
authors.forename: D
authors.initials: D
authors.lastname: Cottel
authors.forename: C
authors.initials: C
authors.lastname: Simon
authors.forename: L
authors.initials: L
authors.lastname: Dauchet
mesh_terms: D000328:Adult; D001288:Attention; D001294:Attitude to Health; D002755:Choice Behavior; D004032:Diet / Q000592:standards*; D004522:Educational Status; D005247:Feeding Behavior; D005260:Female; D058870:Food, Organic; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018673:Nutrition Policy; D012737:Sex Factors